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Central neurocytoma

Case contributed by Assoc Prof Frank Gaillard

Presentation

Headache.

Patient Data

Age: 35 years
Gender: Male
CT

A hyperdense lesion is present in the body of the left ventricle. This demonstrates mild contrast enhancement. No other space-occupying lesion identified. 

MRI

A hemorrhagic lesion is centered within the body of the left lateral ventricle, possibly arising from the choroid plexus abutting the ependyma superiorly, without adjacent vasogenic edema or parenchymal abnormality. It demonstrates intrinsic high T1 signal with superimposed contrast enhancement, some signal loss from hemorrhage and intermediate T2. The lesion demonstrates substantial diffusion restriction (ADC = 620 x 10^-6 mm^2/s ). It is an isolated lesion. No hydrocephalus.

Conclusion: Hemorrhagic intraventricular lesion. If centered within the choroid plexus it may represent a hemorrhagic metastasis, particularly from melanoma or renal cell carcinoma. A central neurocytoma is nonetheless felt to be more likely.

Case Discussion

The patient went on to have a resection.

Histology:

Paraffin sections show small fragments of a moderately cellular tumor. Tumor cells have mildly pleomorphic round and oval nuclei with finely granular chromatin. Nucleoli are conspicuous within larger nuclei of scattered tumor cells. Tumor cells are arranged in diffuse sheets. Cell poor areas with the appearances of neuropil are noted. No mitotic figures are identified. There is no microvascular proliferation and no necrosis is identified.

IMMUNOHISTOCHEMISTRY:

  • Synaptophysin: positive
  • NeuN: positive
  • tubulin: positive
  • Neurofilament protein (NFP): positive
  • GFAP negative
  • topoisomerase proliferation index: ~2%

FINAL DIAGNOSIS: central neurocytoma (WHO Grade II)

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Case information

rID: 65248
Published: 7th Jan 2019
Last edited: 13th May 2020
Inclusion in quiz mode: Included

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